Healthcare Provider Details

I. General information

NPI: 1851193726
Provider Name (Legal Business Name): REEM ISSA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23000 TELEGRAPH RD
BROWNSTOWN TOWNSHIP MI
48134-9265
US

IV. Provider business mailing address

642 MEADOWLANE RD
DEARBORN MI
48124-1170
US

V. Phone/Fax

Practice location:
  • Phone: 734-304-4500
  • Fax:
Mailing address:
  • Phone: 313-938-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704304690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: